By Dr Kayleigh Cox-Nowak, Technical Support Manager, Schülke & Mayr UK Ltd.
Wednesday 5th May marks World Hand Hygiene Day. The ‘SAVE LIVES: Clean Your Hands’ global campaign was first launched in 2009 and is now celebrated annually. This year, the World Health Organisation (WHO) is calling on healthcare staff to ensure effective hand hygiene at the point of care. The 2021 theme is ‘Seconds save lives – clean your hands!’
For hospital staff stringent hand hygiene measures are critical; unclean hands may lead to the transmission of pathogens between patients and staff, resulting in increased morbidity, mortality, and costs related to healthcare-associated infections [Gold, 2020].
Enhanced hand hygiene procedures in clinical settings are an intrinsic element of SARS-CoV-2 prevention.
The stability of SARS- CoV-2 compared to Influenza A Virus (IAV) on human skin has recently been evaluated under laboratory conditions. The survival time of SARS-CoV-2 on the skin was approximately 9 hours and was significantly longer than that of IAV, which was approximately 1.8 hours. This means it is likely that SARS-CoV-2 will have a higher risk of contact transmission than IAV because the first is much more stable on human skin than the latter [Hirose, 2020]. The long survival time of SARS-CoV-2 on human skin may increase the risk of viral invasion in the body and its transmission from the skin to other surfaces or people, with a potential impact on the SARS-CoV-2 pandemic [Hirose, 2020]. When exposed to an ethanol-based disinfectant, the researchers found that both SARS-CoV-2 and IAV on human skin were completely inactivated within 15 seconds. SARS-CoV-2 was inactivated more rapidly on skin surfaces than on other surfaces including stainless steel, glass and plastic [Hirose, 2020].
It was concluded that the ‘survival of SARS-CoV-2 on the skin may increase the risk of contact transmission in comparison with IAV, thus accelerating the pandemic. Proper hand hygiene is important to prevent the spread of SARS-CoV-2 infections’ [Hirose, 2020]. The significance of hand hygiene was recognised early on in the current pandemic, with one of the earliest recommendations from the WHO stating that ‘Hand Hygiene is one of the most effective actions you can take to reduce the spread of pathogens and prevent infections, including the COVID-19 virus.’
In the clinical environment the NHS advises that an alcohol-based hand rub (ABHR) should be used for routine hand hygiene during care, unless the hands are visibly soiled [NHS, 2019]. Hand hygiene with an ABHR is widely accepted as one of the most effective, simple and low-cost procedures to help prevent cross-transmission of pathogens. By denaturing proteins, alcohol inactivates enveloped viruses such as coronaviruses and ABHR formulations with at least 60% ethanol have been proven to be effective for hand hygiene [Lotfinejad, 2020].
In vitro experiments have demonstrated that alcohol solutions are effective against enveloped viruses including severe acute respiratory syndrome coronavirus (SARS), Ebola virus, and Zika virus [Siddharta, 2017].
Ethanol appears to be the most effective alcohol against viruses, but the concentration of alcohol influences its efficacy. One study demonstrated that a hand rub with 85% ethanol content was significantly better at reducing bacterial populations compared to preparations of 60% to 62% ethanol [Gold, 2020]. Conversely, very high alcohol content preparations (95% and above) exhibit reduced efficacy because proteins are more easily denatured in the presence of water.
Most hospital-grade ABHRs are formulated with additional moisturisers to help protect the hands. This is essential in the clinical environment where staff cleanse their hands, on average, at least ten times an hour [Albright, 2018]. A study of 4000 hospital staff showed that each person used a hand sanitiser nine times in an hour and washed their hands twice an hour. This meant that in an eight hour shift, hands were cleansed on average 88 times. Nursing staff practised hand hygiene even more frequently than other workers [Albright, 2018].
Some non-alcohol based hand rubs are available, which contain active ingredients such as chlorhexidine or benzalkonium chloride. Although these actives are antimicrobial, much longer contact times are required for appreciable efficacy to be achieved. Likewise, drying times are considerably longer than those achieved by ABHRs. If a user is allergic to alcohol, the best alternative is likely to be hand-washing with a gentle soap.
Synthetic detergents, often abbreviated to ‘syndets’, are recommended for cleansing sensitive skin as they are more gentle than traditional soaps. They are produced by combining different surfactant detergents. An example of a syndet is sensiva® wash lotion from schülke, which is pH neutral and soap free. It also contains allantoin to protect the skin and is suitable for frequent use.
As experts in infection prevention, schülke is committed to offering an effective range of products for hand hygiene in clinical environments where the highest standards are essential. All products are certified to European (EN) standards and are effective against Covid-19.
However, having effective products achieves little unless they are used correctly and staff understand the importance of hand hygiene. A range of materials including posters and a teaching pack are available to download for free at: https://www.schuelke.com/gb-en/news-media/news.php
There is also a dedicated platform with free online training courses, all researched and designed for healthcare professionals. The courses include modules on hand hygiene during the Covid-19 outbreak and managing hand dermatitis. All courses are CPD accredited and can be undertaken at a time and place convenient to the participant. Find out more here https://www.schuelke-learning.com/
Effective hand hygiene in hospitals has probably never been as important as it is right now. The global messages for 5th May are particularly resonant for staff in helping protect both themselves and their patients from the risk of cross infection.
Albright J, Use patterns and frequency of hand hygiene in healthcare facilities: Analysis of electronic surveillance data, American Journal of Infection Control 2018, 46, 1104-9
Gold NA, Mirza TM, Avva U. Alcohol Sanitizer. [Updated 2020 Jun 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513254/?report=classic
Hirose R, Ikegaya H, Naito Y, et al. Survival of SARS-CoV-2 and influenza virus on the human skin: Importance of hand hygiene in COVID-19 [published online ahead of print, 2020 Oct 3]. Clin Infect Dis. 2020;ciaa1517. doi:10.1093/cid/ciaa1517
Lotfinejad N, Peters A, Pittet D. Hand hygiene and the novel coronavirus pandemic: the role of healthcare workers. J Hosp Infect. 2020;105(4):776-777. doi:10.1016/j.jhin.2020.03.017
NHS Standard infection control precautions: national hand hygiene and personal protective equipment policy Published by NHS England and NHS Improvement, March 2019
Siddharta A, Pfaender S, Vielle NJ, et al. virucidal activity of world health organization-recommended formulations against enveloped viruses, including Zika, Ebola, and emerging coronaviruses. J Infect Dis. 2017;215:902-906.
World Health Organisation, 2020, accessed 26/04/21 https://who.int/infection-prevention/campaigns/clean-hands